Endocrine Abstracts

We undertook a retrospective audit of patients with primary hyperparathyroidism. Patients were identified from the Bradford Endocrine Database.

About 101 patients were identified. 13 were incorrectly labelled and excluded. Case records of 88 patients; median age 64 (range 17–87) years, 69 F:19 M, were examined. At diagnosis median corrected calcium was 2.72 (range 2.45–3.69) mmol/l, median PTH 14 (range 3–182) pmol/l and mean 24 h urine calcium excretion 8.9 (range 2.5–20.7) mmol. Sixty-five (74%) patients performed at least one 24 h urinary calcium excretion and 31% of these patients had mean urine calcium excretion >10 mmol/24 h. Sixty-two (70%) patients had renal tract imaging and renal calculi were found in 9 cases.

Four patients were lost to follow-up and excluded from further analysis. 56 (67%) patients had a DEXA scan performed and median T scores at NOF and LS were −1.90 and −1.79 respectively. Forty-five percent of these patients had a T score of <−2.5. Forty-two (50%) patients were referred for parathyroidectomy. Of those who were referred 39 patients had hypercalcaemia of >0.25 mmol/l above the upper limit of normal, 7 had renal calculi, 16 had osteoporosis and 4 had fragility fractures.

In patients aged <50 years (n=18), 4 patients had renal calculi, 2 had osteoporosis and 1 had a fragility fracture. In patients aged >50 years (n=70), 5 had renal calculi, 23 had osteoporosis and 3 had fragility fractures.

We conclude that; the majority, though not all patients underwent renal and/or bone imaging for assessment of complications. Our current referral pattern for parathyroidectomy is in accordance with the NIH consensus guidelines (2002). We found a high incidence of renal calculi in younger patients, highlighting the importance of renal imaging to detect renal calculi and nephrocalcinosis which may be asymptomatic complications.